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HEALING
DR JITHIN M
WOUND : DEFINITION
• A wound is a break in the integrity of the skin or tissues often, which may be
associated with disruption of the structure and function
CLASSIFICATION OF WOUNDS
I. RANK AND WAKEFIELD CLASSIFICATION
• a. Tidy wounds
• ► They are wounds like surgical incisions and wounds caused by sharp objects.
• ♦ Partial thickness wound with skin loss up to deep dermis with only deepest
part of the dermis, hair follicle shafts and sweat glands are left behind.
• ♦ Full thickness wound with loss of entire skin and subcutaneous tissue
causing spacing out of the skin edges.
• ♦ Deep wounds are the one extending deeper, across deep fascia into
muscles or deeper structures.
• ♦ Penetrating wounds are one which penetrates into either natural cavities
or organs.
CLASSIFICATION BASED ON INVOLVEMENT OF
STRUCTURES
• a. Clean wound
• ► Herniorrhaphy.
• ► Excisions.
• ► Surgeries of the brain, joints, heart, transplant.
• ► Infective rate is less than 2%.
• b. Clean contaminated wound
► Appendicectomy.
► Bowel surgeries.
► Gallbladder, biliary and pancreatic surgeries.
► Infective rate is 10%.
• c. Contaminated wound
• ► Abscess drainage.
• ► Pyocele.
• ► Empyema gallbladder.
• ► Faecal peritonitis.
• ► Infective rate is 40-70%.
WOUND HEALING
• Wound healing is complex method to achieve anatomical and functional
integrity of disrupted tissue by various components like neutrophils,
macrophages, lymphocytes, fibroblasts, collagen ; in an organised staged
pathways —
• haemostasis — > inflammation — > proliferation — > matrix
synthesis(collagen and proteoglycan ground substance) — > maturation — >
remodelling — > epithelialisation — > wound contraction (by myofibroblasts).
TYPES OF WOUND HEALING
PRIMARY HEALING (FIRST INTENTION)
• After wound debridement and control of local infection, wound is closed with
sutures or covered using skin graft.
• Primary contaminated or mixed tissue wounds heal by tertiary intention.
STAGES OF WOUND HEALING
• ♦ Stage of inflammation.
• ♦ Stage of epithelialisation.
• ♦ Stage of maturation.
PHASES OF WOUND HEALING
INFLAMMATORY PHASE (LAG OR SUBSTRATE OR
EXUDATIVE PHASE)
• Infection
• Presence of necrotic tissue and foreign body ,
• Poor blood supply
• Venous or lymph stasis
• Tissue tension
• Haematoma
• Large defect or poor apposition
• Recurrent trauma
• X-ray irradiated area
• Site of wound, e.g. wound over the joints and back has poor healing
• Underlying diseases like osteomyelitis and malignancy
• Mechanism and type of wound — incised/lacerated/crush/ avulsion
• Tissue hypoxia locally reduces macrophage and fibroblast activity
GENERAL FACTORS
• Hypertrophic Scars
• Keloids
HYPERTROPHIC SCARS
• ♦ It is limited to the scar tissue only. It will not extend to normal skin.
• ♦ It is pale brown in colour, not painful, nontender.
• ♦ Recurrence is uncommon.